经皮内镜髓核摘除术治疗腰椎间盘突出症长期随访研究

Percutaneous endoscopic lumbar discectomy in treatment of lumbar disc herniation:a long-term follow-up study

目的评估经皮内镜髓核摘除术治疗腰椎间盘突出症的临床疗效。方法选取2012年1月至2015年12月我科诊断为单节段腰椎间盘突出症并行经皮内镜髓核摘除手术的病例,完成至少5年的术后随访。观测患者术前,术后3个月、6个月、1年及末次随访的腰椎疾病的功能评分(the Oswestry disability index,ODI)及腰、腿部疼痛视觉模拟评分(visual analogue scale,VAS)评分变化;记录术后并发症及其治疗方式。结果共纳入病例1 807例,完成随访病例1 706例,失访101例,随访率为94.08%。随访时间(6.36±1.08)年。术后3个月、6个月、1年及最终随访ODI评分分别为(26.01±7.48)、(20.87±7.50)、(17.25±7.77)及(17.26±13.53)分,较术前[(58.23±13.06)分]均明显下降;术后1年ODI评分较术后3、6个月明显下降。腰部VAS评分术后3个月、6个月、1年及最终随访分别为(2.50±0.83)、(1.93±0.84)、(1.54±0.82)、(1.46±1.28)分,均较术前[(5.48±1.24)分]明显下降;腰部术后1年VAS评分较术后3、6个月明显下降。术后3个月、6个月、1年及最终随访腿部VAS评分分别为(2.00±1.07)、(1.43±1.02)、(1.01±1.01)、(0.89±1.39)分,较术前[(4.73±1.84)分]均有下降。术后并发症发生率为0.53%(9/1 706),包括椎间盘囊肿2例,椎间隙感染2例,邻近节段突出5例。术后症状未缓解11例。术后复发177例,复发率10.38%。术后1年为患者复发高峰时间,61~90岁患者复发率较高。复发再手术率为50.85%,全部再手术率5.98%。复发治疗方式:手术治疗90例,保守治疗87例。结论经皮内镜髓核摘除术治疗腰椎间盘突出症长期随访结果良好。

Objective To evaluate the clinical efficacy of percutaneous endoscopic lumbar discectomy in the treatment of lumbar disc herniation.Methods Patients who received single-level percutaneous endoscopic lumbar discectomy for lumbar disc herniation in our department from January 2012 to December 2015 were recruited and followed up for at least 5 years.Oswestry disability index(ODI) and visual analogue scale(VAS) scores of waist and leg were evaluated preoperatively, 3, 6 and 12 months postoperatively,and at the last follow-up.Postoperative complications and their treatment were recorded and analyzed.Results A total of 1 807 cases were included,of which,1 706 cases were followed up and 101 cases were lost to follow-up,with a follow-up rate of 94.08%.The mean follow-up time was 6.36±1.08 years.The ODI scores at 3,6 and 12 months postoperatively and last follow-up were 26.01±7.48,20.87±7.50,17.25±7.77 and 17.26±13.53,respectively,which were significantly lower than that preoperatively(58.23±13.06).The ODI score at 12 months postoperatively was significantly lower than those at 3 and 6 months postoperatively.The VAS scores of low back at 3,6 and 12 months postoperatively and last follow-up were 2.50±0.83,1.93±0.84,1.54±0.82 and 1.46±1.28,respectively,and all these scores were significantly lower than that preoperatively(5.48±1.24).The score at 12 months postoperatively was obviously lower than those at 3 and 6 months.The VAS scores of leg at 3,6 and 12 months postoperatively and last follow-up were 2.00±1.07,1.43±1.02,1.01±1.01 and 0.89±1.39,respectively,and all of them were significantly lower than the preoperative score(4.73 ± 1.84).The incidence of postoperative complications was 0.53%(9/1 706),including 2 cases of intervertebral disc cyst,2 of intervertebral space infection and 5 of adjacent segment disease.Eleven patients do not relieve postoperatively.The recurrence rate was 10.38% in 177 cases.One year postoperatively was the peak time of disc recurrence,and the patients aged 61 to 90 years had a higher recurrence rate.The reoperation rate for recurrence was 50.85% and total reoperation rate was 5.98%.For the recurrence,90 cases were treated with surgery and 87 cases were treated conservatively.Conclusion Percutaneous endoscopic lumbar discectomy has good long-term follow-up outcomes in the treatment of lumbar disc herniation.